多次玻璃体内注射抗VEGF药物对眼底血管性疾病患者角膜组织形态的影响  

Effects of repeated intravitreal injections of anti-vascular endothelial growth factor drugs on corneal morphology in patients with fundus vascular diseases

作　　者：祁媛媛[1,2] 闫春晓 金翠华 袁琳慧 李胜 张立军 QI Yuanyuan;YAN Chunxiao;JIN Cuihua;YUAN Linhui;LI Sheng;ZHANG Lijun(Dalian Medical University,Dalian 116044,Liaoning Province,China;Key Laboratory of Corneal and Ocular Surface Diseases Research of Liaoning Province&Department of Ophthalmology,the Third People’s Hospital Affiliated to Dalian Medical University,Dalian 116033,Liaoning Province,China)

机构地区：[1]大连医科大学,辽宁省大连市116044 [2]大连医科大学附属大连市第三人民医院眼科辽宁省角膜与眼表疾病重点实验室,辽宁省大连市116033

出　　处：《眼科新进展》2024年第3期230-234,共5页Recent Advances in Ophthalmology

摘　　要：目的 探讨多次玻璃体内注射雷珠单抗和阿柏西普对湿性老年性黄斑变性(nAMD)、糖尿病黄斑水肿(DME)、视网膜静脉阻塞(RVO)患者角膜组织形态的影响。方法 前瞻性临床研究。选取2021年6月至2022年6月在我院眼内科注射中心治疗的患者共64例(64眼)作为研究对象;其中nAMD患者19例,DME患者20例,RVO患者25例。阿柏西普(40 g·L^(-1))治疗29例,雷珠单抗(10 g·L^(-1))治疗35例。所有入组病例均选取单眼注射,采取3+PRN的随访治疗方法。使用共聚焦显微镜行角膜神经检查,使用角膜内皮显微镜进行角膜厚度及角膜内皮细胞检查。比较nAMD、DME、RVO患者多次玻璃体内注射抗VEGF药物后角膜厚度、内皮细胞密度、变异系数、平均面积、六角形细胞比例、神经纤维长度、神经纤维密度,比较每次注射不同药物后1个月与基线时上述指标变化。结果 术前,DME组患者内皮细胞密度低于nAMD组和RVO组,DME组患者内皮细胞平均面积高于nAMD组和RVO组,差异均有统计学意义(均为P<0.05),三种不同疾病患者其余指标差异均无统计学意义(均为P>0.05)。注射抗VEGF药物3次后,DME组患者内皮细胞密度低于nAMD组和RVO组,内皮细胞平均面积高于nAMD组和RVO组,差异均有统计学意义(均为P<0.05);DME组患者神经纤维长度短于nAMD组和RVO组,差异均有统计学意义(均为P<0.05)。自从第2次注射阿柏西普后,nAMD组患者内皮细胞密度均较术前减少,差异均有统计学意义(均为P<0.05);每次注射后六角形细胞比例均较术前减少,差异均有统计学意义(均为P<0.05);其余指标注射后与术前相比,差异均无统计学意义(均为P>0.05)。自从第2次注射雷珠单抗后,RVO组患者内皮细胞密度均较术前减少,差异均有统计学意义(均为P<0.05)。结论 多次玻璃体内注射抗VEGF药物会一定程度降低角膜内皮六角形细胞比例及内皮细胞密度,注射药物后DME组的神经纤维长度显�Objective To observe the effects of repeated intravitreal injections of ranibizumab and aflibercept on corneal morphology of patients with neovascular age-related macular degeneration(nAMD),diabetic macular edema(DME)or retinal vein obstruction(RVO).Methods In this prospective study,64 patients(64 eyes)who underwent therapy in the injection center of the Ophthalmology Department of our hospital from June 2021 to June 2022 were enrolled,including 19 nAMD patients,20 DME patients and 25 RVO patients.Among these patients,29 were treated with aflibercept(40 g·L^(-1))and 35 were treated with ranibizumab(10 g·L^(-1)).Monocular injections were adopted for all patients,and 3+pro re nata(PRN)therapy was used.Confocal microscope was used for corneal nerve examination,and corneal endothelial microscope was used to measure corneal thickness(CT)and corneal endothelial cells.The CT,corneal endothelial cell density(ECD),coefficient of variation(CV),average cell size(ACS),proportion of hexagonal cells(Hex%),corneal nerve fiber length(CNFL),corneal nerve fiber density(CNFD)of patients with nAMD,DME and RVO after repeated intravitreal injections of anti-vascular endothelial growth factor(VEGF)drugs were compared,and those parameters at 1 month after injection of different anti-VEGF drugs were compared with the baseline.Results Before injection,ECD in the DME group was lower than that in the nAMD and RVO groups,and the ACS in the DME group was higher than that in the nAMD and RVO groups(all P<0.05).There was no significant difference in the other indexes among the three groups(all P>0.05).After 3 injections of anti-VEGF drugs,the ECD in the DME group was lower than that in the nAMD and RVO groups,the ACS in the DME group was higher than that in the nAMD and RVO groups,and the CNFL in the DME group was lower than that in the nAMD and RVO groups(all P<0.05).The ECD decreased compared with that before injection from the 2nd injection of aflibercept in the nAMD group(all P<0.05).Hex%decreased significantly after each injection compar

关 键 词：抗血管内皮生长因子 内皮细胞密度 角膜神经 阿柏西普 雷珠单抗 

分 类 号：R772.2[医药卫生—眼科]